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Mental, emotional, and behavioral disorders are preventable - Letter to the Wall Street Journal signed by 23 leading prevention scientists

Note: For those of you reading this post for the first time as a part of Friday Update, 7-10-15, know that the original post was written 5-1-14. We are featuring the original post again, as we have received a number of requests for some of the more popular background posts written about HR 3717 that are still relevant to current discussions about H.R. 2646.

Morning Zen Guest Blogger ~ Dennis Embry

Note: This post was originally sent to the Wall Street Journal as a response to an editorial that focused on HR 3717 – The Helping Families in Mental Health Crisis Act. As this response has not yet been published in the Wall Street Journal, Dr. Embry has given the Children's Mental Health Network permission to feature it on our website as a Morning Zen post. We are most happy to continue the growth of knowledge about effective strategies for meeting the needs of youth with emotional challenges and their families.

Mental, Emotional, and Behavioral Disorders Are Preventable. Letter to the Wall Street Journal Signed by 23 Leading Prevention ScientistsThe Wall Street Journal editorial of April 1, 2014 (The Definition of Insanity) stated, “...there is no known way to prevent severe mental illness.” This statement is scientifically and verifiably false, easily established by the scores of gold-standard, randomized control studies indexed in the US National Library of Medicine (www.pubmed.gov). These are studies funded by the National Institutes of Health, the Centers for Disease Control and Prevention, private foundations, or comparable entities in OECD countries. Many of these prevention studies include long-term, randomized control follow-up from five to twenty years later, much longer than any preserved randomized psychotropic medication study published at pubmed.gov.

Further, the highest independent entities for such issues in the United States - the National Research Council and the Institute of Medicine (both chartered by Congress in 1863) - issued a significant and influential report in 2009, Preventing Mental, Emotional, and Behavioral Disorders Among Young People.(1) Page 1 of that report, which is based on an extensive review of the scientific literature, concludes unequivocally that several evidence-based practices are available now to prevent or delay mental illnesses among children and adolescents. The report then reviews the relevant literature for each developmental phase and setting (e.g., family, school, community) of the nation’s young people.

The signatories of this letter are among the scientists whose work has shown in gold-standard, randomized longitudinal control studies to prevent, avert, or reduce one or more than one mental illness, including members of the IOM Committee issuing the finding that mental illnesses are preventable. We note that one of the witnesses at Congressman Murphy’s hearings was Dr. E. Fuller Torrey, who is the Executive Director of the Stanley Medical Research Institute that funded the first randomized, longitudinal trial to prevent first episode psychosis(2)—the proximal condition that triggered the events in Tucson, Virginia Tech, and Aurora. That study was published in the Archives of General Psychiatry, an official publication of the American Medical Association. There are replications already happening. Other gold-standard studies protect against or prevent the much earlier predictors of serious mental illness and, then in turn, can prevent serious conditions in later life.

The editorial misses the verifiable fact that scores of strategies on the National Registry of Evidence-Based Programs and Practices (operated by the Substance Abuse and Mental Health Services Administration) are proven to prevent, reduce, treat, and even help people recover from serious mental, emotional, or behavioral disorders. Many of the same practices can be found on the list of the non-partisan, independent Coalition for Evidence Based Policy. Sadly, members of Congress, Governors, state legislators, mayors and families across America have scant awareness any of these rigorously proven preventive strategies, which are well documented to collectively save local, state, and the federal governments billions by the independent analyses from the Washington State Institute for Public Policy.

Other countries have lower prevalence rates of mental, emotional, and behavioral disorders, perhaps because they are using the prevention science that United States citizens developed, U.S. taxpayers and foundations funded. A front-page article in the WSJ on December 28, 2010(3) pointed out that 40 million out of 75 million young people in the US had at least one prescription for a psychotropic medication, suggesting we cannot treat our way out of the epidemic. We cordially invite the Wall Street Journal to have its excellent reporters create a series of articles based on the world-class, gold-standard science that can prevent, reduce, or avert mental, emotional, and behavioral disorders that are now epidemic in the United States.

Diana Fishbein, Ph.D., Director/Professor, Center for Translational Research on Adversity, Neurodevelopment and Substance abuse (C-TRANS), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD

Emilie Phillips Smith, Ph.D., Professor, Human Development and Family Studies, Pennsylvania State University, University Park, PA

Faith Elizabeth Fuller MBA, President of Financial, Analytic, and Strategic Services for Nonprofit and Government Agencies, Berkeley CA

National Research Council & Institute of Medicine (2009). Preventing mental, emotional, and behavioral disorders among young people: progress and possibilities. Washington, DC: National Academies of Science, pp. 576.

Mathews, A. W. (2010, December 28). So young and so many pills: More than 25% of kids and teens in the U.S. take prescriptions on a regular basis, Wall Street Journal.

Dennis D. Embry, Ph.D., is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues is cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by 23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America.

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Comments

Dear Ms. Pogliano, I am so sorry for your son's struggle that culminated in his death and your painful loss. You don't know that I have such losses in my own family. Nothing in prevention science suggests that you were responsible, any more than the work at Johns Hopkins 60 years ago on the polio vaccine suggests parents were responsible for polio in there children. If your son had had a deadly case of polio (a viral disease), I doubt that you would be mad at the people who discovered a preventive cure for polio.

We are stuck in the era thinking of iron lungs and braces when it comes to serious mental illness, though we have good science now on the possibility of prevention. For example, Dr. E. Fuller Torrey funded the first randomized control study to prevent first episode psychosis, which cost about $13 per patient. That is just one thing about the proven possibility such prevention.

So ask yourself, if you learned that there were objective, scientifically proven ways to prevent serious mental illnesses, what would want to do with that information?

PS. I am a co-investigator on multiple projects at Hopkins to prevent mental illnesses, the same place your son received treatment.

Laura Pogliano

Thanks. My son just died after a 7 year gruesome battle and I gather now that his schizophrenia was MY fault. He didn't have a behavioral problem: he had a progressive chronic brain disease. He wasn't traumatized or abused or a victim of bad or intrusive parenting: he was a perfectly normal, loved and cherished, a great kid, with musical and sports abilities and dozens of friends and good grades. Then he got sick and then he got worse, even with all the wonderful, impeccable care at Johns Hopkins for seven years, and then he got an enlarged heart and then he died. Where does prevention come into this narrative? I watched a brain disease ravage his body and mind. Too bad you all weren't around for the mysterious prevention stage. UGH.

George Patrin

walt stawicki

Linda Wagner has a too common story and while I sympathize with her, I am not ready to convert and advocate throwing out the treatment nor the drug treatment. Until such time, if ever, that no child exhibits any "Mental, Emotional, and Behavioral Disorders" we will be dealing with interactions other than prevention, or if you permit me use of the the word... treatment.
What a nice world it could be, no random trauma, no wars, no drug infested home or community, no less than perfect genetic predisposition (may I suggest that here?).
and for people like Linda Wagner, no doctors who think they have a hammer for all patients. For that is the fact of what she encountered, a doctor who was on a mission, self appointed, to save patients with no regards to what else might ail them. We call this crimninal disregard in some rooms and filings, charitably we talk of malpractice. I suggest that it is so common that we should temper it even more and talk of "due diligence" and furthermore suggest that since only 20% of these powerful drugs prescriptions are written by men and women who are in any way to be called experts, .I suggest we consider restricting the privlege to those who kow what they are doing, and that the further do due diligence to satisfy all parties that the symptoms are not "side effects" of one among so many "biological" illnesses that have "mental" "side effects". Then perhaps we will have some sane footing to address this raging epidemic, or at least separate the biologogical causations from the environmental...but I doubt it will ever separate so cleanly, beint a matter of all of the above, necessary and sufficient being then, only theoretuical frames.
Yes, to prevent epigenetic resets in utero. What a fine ideal, quite in keeping with a new world, needing no pills for anything. To catch the psychosis from Bromine poisoning before a years drugging! To remember to check irritable bowel and that pesky serotonin in gut system, to check lymes and mitochondrial and all the para-depressive symptomologies. To do so with talk? No I think it will still be part of medicine, once it is removed from "behavioralism." for you see the behavioralism you would employ is so much a part of the problem. doctors dont look for real symptoms, they look at behavioral signs. That might be bad for patients, but its worse for the science because it has undermined public trust, just as others over using and misusing antibiotics have caused problems with communicable diseases (some of which, as I recall, have "behavioral" effects. I think you will admit Alzheimers is a biological disease, of course not a catching one?
Stay brave, your new world is near, I'm sure. With P.C. and stressless existence for all.

Nearly 45 years ago, I had an unfortunate encounter at age 17 with a psychiatric drug researcher who mistakenly diagnosed me as a schizophrenic and prescribed the anti-psychotic drug Trilafon on the sole basis of a meeting with my mother. That encounter precipitated decades of struggle with depression and anxiety. I now work in the public health field and I hope we can bring the message of prevention to the forefront. Too often, treatment that is based on a lack of evidence is the real problem.

Thank you for the kind words. The sheer fact that the prevalence rates are increasing every two years, as reported in the studies cited by the IOM report, reveal logically that this cannot be some invariant, deterministic genetic disorder. Indeed, one our recent studies show that either a simple classroom intervention like the PAX Good Behavior Game or universal parenting supports both altered the epigenetic expression of BDNF (Brain Derived Neurotropic Factor) that protects against mental illness. It's time that people understand that prevention powerfully, scientifically proven.

Thank you so much for posting this encouraging response! Just yesterday, I expressed my disappointment on Facebook that the presidential proclamation of National Mental Health Awareness Month, 2014 didn't include a single word about prevention. Rather, it was centered around screening and treatment (which I'm assuming for the most part means drugs). In the process of writing a book that was supposed to be part psychiatric survivor story (my daughter's) and part alternate treatment options, I realized just how big this epidemic is among kids and teens. Because of this, I added an additional (and the most important) part to my book focused on how we can design a society that optimizes mental health. Many preventative measures are free and accessible to all. If we're going to end this mental health epidemic, it's got to start with the kids and their parents and teachers. It's happening.